1. Field of the Invention
The present invention relates to an endoscopic surgical device and an overtube, and particularly, relates to an endoscopic surgical device and an overtube that can operate an endoscope and a treatment tool inserted through two insertion passages provided in the overtube in an interlocking manner.
2. Description of the Related Art
In recent years, since invasion to a patient is small compared to surgery in which a laparotomy, a thoracotomy, or the like, is performed, endoscopic surgery using endoscopes (hard endoscopes), such as a laparoscope, has been widely performed. In endoscopic surgery, a plurality of holes are made in a patient's body wall, an endoscope is inserted into a body cavity from one hole of these, and a treatment tool is inserted into the body cavity from another hole. Then, treatment of a living body tissue is performed with the treatment tool while observing the living body tissue within the body cavity with the endoscope.
Generally, in endoscopic surgery, one or a plurality of treatment tools are used simultaneously with the endoscope. Therefore, since it is difficult for one surgeon to simultaneously operate the endoscope and the plurality of treatment tools, for example, a task, such as operating a treatment tool that the surgeon holds with his/her both hands while making an assistant called an endoscopic technician operate the endoscope is normally performed.
In this way, in endoscopic surgery, it is usual that the surgeon's hands are occupied by the operation of the treatment tool, and the operation of the endoscope is performed by the assistant. Therefore, in a case where the observation position of the endoscope is changed, the surgeon needs to give sequential instructions to the assistant. Hence, the task of correctly directing the orientation of the endoscope to a direction desired by the surgeon is difficult, and stress is likely to be imposed on the surgeon. Additionally, since the assistant performs an operation after the surgeon issues an instruction, there is a tendency that surgery time is likely to be prolonged. Additionally, the assistant needs to operate the endoscope so as not to interfere with a surgeon's procedure, and the operation is likely to become complicated.
In contrast, the present applicant suggests the following technique. In this technique, an overtube that guides an insertion part of an endoscope and an insertion part of a treatment tool into a body cavity includes a tubular overtube body that is inserted in a state where the insertion part of the endoscope and the insertion part of the treatment tool are made to be parallel to each other, a movable body that is movable in an axial direction and has an endoscope holding part and a treatment tool holding part is provided inside the overtube body, the insertion part of the endoscope and the insertion part of the treatment tool are held by the respective holding parts in a state where the insertion parts are made to be parallel to each other, and if the insertion part of the treatment tool is moved in the axial direction, the insertion part of the endoscope also moves in the axial direction in an interlocking manner with this movement (refer to WO2013/176167A). According to this technique, the number of holes made in the patient's body wall can be reduced, the invasion to a patient can be reduced, and the visual field of the endoscope can be easily changed while the surgeon operates the treatment tool without asking for an assistant's help.
Meanwhile, in an overtube (trocar sleeve) disclosed in JP2011-224376A, a shaft-shaped central portion of an endoscope with a high rigidity, and a shaft portion of a treatment tool are inserted in the state where these portions are made to be parallel to each other. However, in order to prevent interference between the endoscope and the treatment tool inside and outside a body cavity, an operating portion connected to a proximal side of the shaft-shaped central portion of the endoscope and a distal end portion connected to a distal side (body cavity side) are arranged so as to be offset or inclined with respect to a longitudinal axis of the shaft-shaped central portion.
Additionally, JP1998-94513A (JP-H10-94513A) discloses a configuration in which, in an endoscopic surgical device having a tubular member (tube shaft) including an optical system and a work passage, an inclined part having a guide groove is provided inside the tubular member, and a distal end of the optical system is bent toward a treatment tool (work tool) inserted through the work passage by the guide groove of the inclined part so that a work area of the treatment tool can be observed by the optical system.